Cephalosporins

 

First Generation
Cefadroxil Duricef ® TOP ORAL	Dosing (Adults): 1-2 grams per day divided qd or q12h.    Renal Dosing:  [CRCL >50 ]: No change.   [25-50 ]: 1 gram x 1, then 500mg q12h.  [10-25 ]: 1 gram po x 1, then 500mg q24h.  [<10 ]: 1 gram x 1, then 500 mg q36h. Hemodialysis:  1 gram x 1, then 500 mg q36h. Dose should be given after dialysis on dialysis days. Alternatively, give 1 gram after each hemodialysis session plus an additional 1 gram dose q72h.
Cefazolin Ancef ® TOP	[Dosing -Usual]: 500mg to 1g IV q8h.  [Moderate to severe]: 500mg – 1 gram q6-8h.  [life-threatening]: 1–2 grams q6h.  [Maximum dosage/day]: 12 grams. Renal dosing:  [CRCL >55 ml/min]: no change.   [35-54 ml/min]: Maximum interval: q8h. 500mg – 1.5g q8h.  [11-34 ml/min]: 500mg – 1.5g x 1, then 0.5 - 1 gram q12h.  [<10 ml/min]: 500 mg - 1 gram q18-24h. Hemodialysis:  500 mg – 1 gram IV q24h. (Give dose post-dialysis on dialysis days.)  PD: 500 mg q12h.
Cephradine Velosef ® TOP ORAL	Dosing (Adults):  250-500 mg every 6-12 hours Renal Dosing: [CRCL 10-50 ml/min]: Administer 50% of dose. [<10 ml/min]:  Administer 25% of dose.
Cephalexin Keflex ® TOP ORAL	Dosing (usual):  250 – 500mg po q6h.  [Severe infections]: 1 gm q6h. (Maximum: 4 g/day). Other:  Streptococcal pharyngitis, skin and skin structure infections: 500 mg orally q12h.  Uncomplicated cystitis: 500 mg orally q12h.  Renal Dosing: [CRCL >30 ]: no changes.  [10-30 ]: 250-500 mg q8-12h.   [<10 ]: 250-500mg q12-24h.  Hemodialysis:  250-500mg q12-24h (Dose should be given after dialysis on dialysis days).
Second Generation
Cefaclor Ceclor ® TOP ORAL	Dosing (Adults): 250–500 mg orally every 8 hours or if the extended release form is used: 375–500 mg every 12 hours.     Renal dosing:  [CRCL >10 ]: no change.   [<10 ]: Give 50% of usual dose at same interval.   Hemodialysis: 250mg q8-12 hours. Make sure dose is given after dialysis.
Cefotetan  TOP	Dosing (Adults): 1-2 grams q12h.  [Life-threatening]: 3 grams IV q12h. Renal Dosing: [CRCL >30 ml/min]: No changes.   [10-30 ]: 1-2g q24h or 500mg-1g q12h.   [<10 ]: 1-2 grams q48h or 250-500mg q12h.   Hemodialysis: 250 - 500 mg q24h on non-HD days and 500 mg - 1 gm q24h on HD days.  PD: 1 gram q24h
Cefoxitin Mefoxin ®   TOP	Dosing (Adults): [Uncomplicated]: 1 gm q6-8h. [Moderate to severe]: 1 gram q4h or 2 gm q6-8h.  [Life-threatening]: 2 gm q4h or 3 gm q6h. Renal Dosing: [CRCL >50 ml/min]: No changes.   [30-50 ]: 1-2 grams q8-12 hours.    [10-29 ]: 1-2 grams q12-24 hours.  [5-9 ]: 0.5 - 1 gm q12-24h.   [<5 ]: 0.5 to 1 gram q24-48h.   Hemodialysis: 500mg to 1 gram q24-48h. Also, give a supplemental dose after each dialysis (usual dose: 1 gram).  PD: 1 gram q24h
Cefprozil Cefzil ® TOP ORAL	Dosing (Adults): 250 – 500 mg po q12h.  Specific guidelines: Pharyngitis/tonsillitis: 500 mg orally every 24 hours x 10 days.  Secondary or acute exacerbation of chronic bronchitis: 500 mg orally every 12 hours x 10 days. Renal Dosing: [CRCL >30 ]: No changes.    [<29 ]: 50% of usual dosage q12-24h.   Hemodialysis:  50% of usual dosage q12-24h. (Administer after the completion of hemodialysis on dialysis days).
Cefuroxime Zinacef ® TOP	Dosing (Adults): 750 mg to 1.5 gm IV q8h. Renal Dosing: [CRCL >20 ml/min]: no changes  (750 mg to 1.5 gm IV q8h).  [10-20 ]: 750 mg q12h.   [<10 ]: 750 mg q24h.  Hemodialysis:  750mg q24h. Repeat the dose at the end of dialysis.   PD: 750 mg q24h.
Cefuroxime axetil Ceftin ® TOP ORAL	Dosing (Adults): 250 – 500mg orally q12h.  Renal Dosing: [CRCL >10 ml/min]: no changes.   [<10 ]: give 250mg q24h.   Hemodialysis:  Give 250 mg q24h. Repeat the dose after dialysis.
loracarbef Lorabid ® TOP ORAL	Dosing (Adults): Skin and soft tissue infections: 200 mg orally every 12 hours x 7 days.    Uncomplicated urinary tract infections: 200 mg once daily for 7 days.    Uncomplicated pyelonephritis: 400 mg orally  every 12 hours for 14 days.   Pharyngitis/tonsillitis:  200 mg orally every 12 hours for 10 days.   Sinusitis: 400 mg orally every 12 hours for 10 days.  Upper/lower respiratory tract infection: 400 mg orally every 12 hours for 7-14 days. Renal Dosing: [CRCL >50 ml/min]: no changes.   [CRCL 10-49 ml/min]: Administer 50% of usual dose at usual interval or usual dose given half as often. [CRCL <10 mL/min]: Administer usual dose every 3-5 days. [Hemodialysis]: Doses should be administered after dialysis sessions. Supplied:  200 mg, 400 mg capsule.   Powder for oral suspension: 100 mg/5 ml (100 ml); 200 mg/5 ml (100 ml).
Third Generation
Cefdinir:  Omnicef ® TOP ORAL	Dosing (Adults): 1) Acute exacerbations of chronic bronchitis, pharyngitis , tonsillitis: 300 mg orally twice daily for 5-10 days or 600 mg once daily for 10 days.   2) Community-acquired pneumonia, uncomplicated skin and skin structure infections: 300 mg orally twice daily for 10 days.    3)  Acute maxillary sinusitis: 300 mg orally twice daily or 600 mg once daily for 10 days   Renal Dosing:  [CRCL >30 ml/min]: no change.  [<30 ]: 300 mg q24h. Hemodialysis:  Give 300mg qod. On dialysis days, give 300mg after dialysis.
Cefixime Suprax® TOP ORAL	Dosing (Adults): 400 mg orally once daily or 200mg twice daily.  Uncomplicated cervical/urethral gonorrhea due to N. gonorrhoeae:400 mg orally x 1. Renal Dosing:  [CRCL >60 ml/min]: no change.   [21-60]: Administer 75% of the standard dose.  [<20 ml/min]: Administer 50% of the standard dose.
Cefoperazone Cefobid ® TOP	Dosing (Adults): 1-2 grams q8-12 hours.  Renal dosing: no changes needed.  Hemodialysis: No changes needed. (Ideally, dosage should be scheduled following a dialysis period).
Cefotaxime Claforan ® TOP	Dosing (Adults): [Uncomplicated]: 1 gram IV/IM q12h.  [Moderate to severe]: 1-2 grams IV/IM q8h.  [Severe]: 2 grams IV q6-8h.  [Life-threatening]: 2 grams IV q4h Renal Dosing: [CRCL >50 ml/min]: no change.   [10-50 ]: 1-2 grams q8-12h.   [<10 ] : 1-2 grams q24h.  Hemodialysis:  500mg to 2 grams q24h, plus give a supplemental dose post-dialysis. PD: 1 gram q24h
Cefpodoxime Vantin ® TOP ORAL	Dosing (Adults): 100 to 400 mg orally every 12h hours. -Acute community-acquired pneumonia and bacterial exacerbations of chronic bronchitis: 200 mg orally every 12 hours x 10-14 days.  -Acute maxillary sinusitis: 200 mg orally every 12 hours x 10 days.   -Skin / skin structure: Oral: 400 mg every 12 hours x 7-14 days.  UTI: 100 mg  orally every 12 hours x 7 days. Renal Dosing: [CRCL >30 ml/min]: no changes.   [<30 ]: 100 to 400mg q24h.  Hemodialysis:  Give 100 to 400 mg 3 times per week (after dialysis).
Ceftazidime Fortaz ®   TOP	Dosing (usual): 1 gram IV q8-12 hours.  [Severe / Life-threatening]: 2 grams q8 hours.  (Max 6 grams/day). Bone and joint infections: 2 grams IV q12h. Intra-abdominal or gynecologic infection:  2 g IV q8h. Meningitis: 2 g IV q8h. Skin and soft tissue infections: 0.5 to 1 g IV q8h. UTI: 250-500mg IV q8-12 hours Renal Dosing: [CRCL >50 ]: No changes.   [31-50 ]: 1 gram q12h.   [16-30 ]: 1 gram q24h.    [6-15 ]: 500 mg q24h.   [<5 –dialysis]: 500 mg q48h.  Note: all dosages listed for renal insufficiency may be increased by 50% in severe infections.    Hemodialysis:  Loading dose: 1 gram x 1, then 1 gram after each hemodialysis session.   [Alternatively]: Give 1 gram q48h, plus give an additional 1 gram dose after each dialysis session.  CAPD: 1 gram x 1, followed by 500mg q24h.
Ceftibuten Cedax ® TOP ORAL	Dosing (Adults): 400 mg orally q24h. Renal Dosing: [CRCL > 50 ]: no changes.   [30-49 ]: 200 mg q24h.   [0-29 ]: 100 mg q24h.  Hemodialysis:  Give 400mg after each hemodialysis session.
Ceftizoxime Cefizox ®   TOP	Dosing (Adults): 1-2 grams IV/IM q8-12 hours.  [Life-threatening]: 3-4 gm IV q8h or 2 gm q4h. Renal Dosing: [CRCL >79 ]: no changes.   [50-79 ]: 500 mg to 1.5 gm q8h.   [5-49 ]: 250mg – 1 gm q12h.   [0-4 – dialysis pt]: 250-500 mg q24h or 500mg to 1 gm q48h.   Hemodialysis:  250-500 mg q24h or 500mg to 1 gram q48h (dosages should be timed after hemodialysis on dialysis days.)  PD: 500mg – 1 gram q24h.
Ceftriaxone Rocephin ®   TOP	Dosing (Adults): 1-2 grams q12-24h. [Meningitis]: Give 100 mg/kg/day (not to exceed 4 grams) qd or in divided doses q12h. Other: Gonococcal infection (uncomplicated): 125-250 mg IM x 1.    PID:  250 mg IM x 1.   Renal Dosing: No adjustments are necessary, however, blood levels are recommended in dialysis patients. Adults with both renal and hepatic failure should not receive more than 2 gm/day.   Hemodialysis:  No specific recommendations per manufacturer except that blood levels are recommended in dialysis patients. The dosage should not exceed 2 grams per day. Some studies have recommended giving cefriaxone 1 gram q48h making sure the dose is given after hemodialysis on dialysis days.  PD: 750mg q12h.
Forth Generation
Cefepime Maxipime ®   TOP	Dosing (Adults): [Mild to moderate]: 500 mg to 1 gram IV q12h.  [Moderate to severe]: 1-2 grams IV q12h.  [Febrile neutropenic patients]: 2 grams IV q8h. Renal Dosing: [CRCL >60 ml/min]: no change. [30-60 ]: 500mg to 2 grams q24h. Neutropenic: 2 grams q12h.  [11-29 ]: 500 mg to 1 gram q24h. Neutropenic: 2 grams q24h.  [<11 ]: 250 – 500 mg q24h. Neutropenic: 1 gram q24h. Hemodialysis:  250 – 500 mg q24h. Neutropenic: 1 gram q24h. // Give additional dose post dialysis.  PD: 1-2 grams q48h